Provider Demographics
NPI:1821336751
Name:RIDGEFIELD CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:RIDGEFIELD CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:COVERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:360-936-7146
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-0214
Mailing Address - Country:US
Mailing Address - Phone:360-936-7146
Mailing Address - Fax:360-887-2984
Practice Address - Street 1:414 PIONEER ST
Practice Address - Street 2:SUITE A
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-4512
Practice Address - Country:US
Practice Address - Phone:360-936-7146
Practice Address - Fax:360-887-2984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty